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Learning Objectives/Outcomes: After participating in this CME/CNE activity, physicians and nurses should be better able to:1. Delineate the professional terminology related to the management of pain in a transgender patient. 2. List health and health care disparities faced by transgender persons. 3. Identify difficulties that might occur in pain management for a transgender patient. 4. Evaluate the medical history of transgender patients pertinent to their pain management in a sensitive and respectful manner. 5. Formulate a sensitive and informed communication approach to a transgender patient in the pain management practice setting.

L ow back pain (LBP) is a common symptom, and patients often present to interventional pain specialists for an epidural steroid injection (ESI). However, much of the data surrounding the efficacy of ESI for LBP is conflicting. Part 1 of this 2-part series is a general review of the literature with best available recommendations. In part 2, some of the more relevant articles analyzed are reviewed as an appendix.The goal of this systematic review article is to determine under which conditions an ESI may be helpful for LBP. All meta-analyses and clinical trials known by the authors to have been published within the last 5 years were reviewed.In the review, there was a vast degree of heterogeneity in causes of LBP, injection approach, volume, and composition. The data demonstrated consistent level I evidence supporting the use of ESI for short-term relief of radicular pain from herniated discs, with a transforaminal approach being the most common technique. For spinal stenosis, epidural injections with or without steroids were equally effective and superior to placebo or to no epidural injection.The results suggest that the cause of LBP is likely an important factor for determining whether an epidural injection will Learning Objectives: After participating in this CME activity, the physician should be better able to: 1. Explain the current literature regarding the efficacy of lumbar epidural injections for low back pain. 2. Understand the effect that approach may have on the efficacy of epidural injections. 3. Describe variables in injected medications and how they affect the efficacy of lumbar epidural injections. 4. Increase awareness about the challenges that exist in studying epidural injection efficacy for low back pain.

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